Drug misuse predicts protracted hospital stay for schizophrenia patients

Sep 26 2013

By Eleanor McDermid, Senior medwireNews Reporter

Patients hospitalized with schizophrenia have more severe symptoms and spend longer in hospital if they have a concurrent substance use disorder (SUD), report researchers.

Francesco Oliva (University of Turin, Italy) and team studied 130 schizophrenia patients, 60 of whom had an SUD. All of the patients with an SUD used cannabis, while 32% also used cocaine, 15% amphetamines, 13% LSD, and 5% heroine; 42% used two or more drugs.

In line with previous research, patients with SUDs were more likely than those without to be male, unmarried and unemployed, and to have a younger age at schizophrenia onset.

The SUD patients had significantly higher Brief Psychiatric Rating Scale (BPRS) scores than the patients without an SUD, at an average of 53.0 versus 49.4. They had significantly more severe symptoms on the disorganization subscale, but not on those for thought disturbance, anergia, or affect.

The two groups had different symptom trajectories during their hospital stays. Patients with SUDs made a slower recovery, with their average total BPRS score falling to 43.4 after 1 week of treatment, compared with 34.9 in the non-SUD group. The pattern of less rapid improvement among SUD patients was present for all BPRS subscales, including those for which there were no initial differences from the non-SUD group.

The researchers note that the effects of substance withdrawal could be partly responsible for the slower response to treatment in the SUD group.

By the time of discharge, total BPRS scores were not significantly different between the groups; however, patients with SUDs remained in hospital an average of 17.1 days, compared with 12.8 days for those without.

Thus “it seems that the SUD patients need longer duration of treatment to achieve the same level of overall symptoms improvement required for discharge,” write Oliva et al in Psychiatry Research.

But even by the time of discharge, patients with SUDs still had significantly higher scores on the disorganization subscale than those without SUDs, at 6.1 versus 4.9. Because this was the only subscale that was significantly increased in SUD patients at admission, the team suggests that “disorganization seems to be the psychopathological dimension that better represents the overlapped substances induced psychosis.”

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